Clinicopathological comparison of VHL expression as a prognostic tumor marker in renal cell carcinoma: A single center experience.

AIM: To assess the VHL gene expression as a prognostic marker in Renal Cell Carcinoma (RCC) and compare it with clinicopathologic features. MATERIALS AND METHODS: This retrospective observational study was conducted in the department of Urology and Renal Transplantation in Sri Ramachandra Institute of Higher Education and Research, Chennai from August 2016 to August 2018. Thirty patients who have undergone a radical/partial nephrectomy with biopsy proven histological diagnosis of RCC during the study period were included in the study. Data was analyzed using Statistical package for Social Sciences version 17. RESULTS: A complete loss and retained VHL expression were noted in 60% and 40% of the RCC specimens. Association between smoking and VHL expression was found to be statistically significant. There was no statistical significance found between age group, sex, chief complaints, BMI. ECOG score, hypertension, family history, location of tumor, calcification, venous system or lymphnode involvement. However, rT staging, nature of lesion and cut surface, HPE type, pT staging, HPE grade, necrosis and lympho-vascular invasion were also found to be statistically significant. CONCLUSION: Complete loss of VHL expression was noted in majority of the specimens that leads to the development of RCC. Smoking has been found to be statistically significant in tumors that retain VHL expression which may contributes to more aggressive form of tumor. Association between rT staging, nature of lesion and cut surface, HPE type, pT staging, HPE grade, necrosis and lympho-vascular invasion were also found to be statistically significant.

Glioblastoma invasion and NMDA receptors: A novel prospect.

PURPOSE: Glioblastoma cells create glutamate-rich tumor microenvironment, which initiates activation of ion channels and modulates downstream intracellular signaling. N-methyl-D-aspartate receptors (NMDARs; a type of glutamate receptors) have a high affinity for glutamate. The role of NMDAR activation on invasion of glioblastoma cells and the crosstalk with α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs) is yet to be explored. MAIN METHODS: LN18, U251MG, and patient-derived glioblastoma cells were stimulated with NMDA to activate NMDAR glutamate receptors. The role of NMDAR activation on invasion and migration and its crosstalk with AMPAR were evaluated. Invasion and migration of glioblastoma cells were investigated by in vitro trans-well Matrigel invasion and trans-well migration assays, respectively. Expression of NMDARs and AMPARs at transcript level was evaluated by quantitative real-time polymerase chain reaction. RESULTS: We determined that NMDA stimulation leads to enhanced invasion in LN18, U251MG, and patient-derived glioblastoma cells, whereas inhibition of NMDAR using MK-801, a non-competitive antagonist of the NMDAR, significantly decreased the invasive capacity. Concordant with these findings, migration was significantly augmented by NMDAR in both cell lines. Furthermore, NMDA stimulation upregulated the expression of GluN2 and GluA1 subunits at the transcript level. CONCLUSIONS: This study demonstrated the previously unexplored role of NMDAR in invasion of glioblastoma cells. Furthermore, the expression of the GluN2 subunit of NMDAR and the differential overexpression of the GluA1 subunit of AMPAR in both cell lines provide a plausible rationale of crosstalk between these calcium-permeable subunits in the glutamate-rich microenvironment of glioblastoma.

Dentigerous Cysts of Maxillofacial Region- Clinical, Radiographic and Biochemical Analysis.

BACKGROUND: Dentigerous cyst is the second most common type of odontogenic cysts that encloses the crown of an unerupted tooth by expansion of its follicle due to the collection of cystic fluid. In view of the capability of these lesions attaining a marked size if not diagnosed early and treated properly, the present study was done based on the clinical and radiographic presentation of the dentigerous cyst in addition to the analysis of the cystic contents. OBJECTIVE: The present study reported 14 cases of dentigerous cysts (DC) with their incidence and relative distribution of the maxillofacial region along with the clinical and radiographic features and biochemical analysis of cystic fluid. METHOD: The study was conducted at Sri Govind Tricentenary Dental College, Hospital and Research Institute, Gurgaon, Haryana for a period of one year and six months. A detailed case history and thorough clinical examination was done for the patients who were provisionally found to have odontogenic cysts. Necessary radiographs, aspiration of the cystic fluid and incisional biopsy were performed to the 14 patients who were provisionally diagnosed with dentigerous cysts (DC) after obtaining the informed consent and the cystic fluid was subjected to biochemical analysis. RESULTS: Majority of the affected patients with DC were in their second decade and showed more predilection for mandible with a male predominance. The area of predilection was third molar region in the mandible and it is the canine region in maxilla. All the cases were associated with impacted teeth and majority showed expansion of the buccal/labial cortical plate. The various biochemical variables (total protein content, albumin, globulin and albumin: globulin ratio) were also assessed in the present study. CONCLUSION: The awareness of protean features of DC evident through this study is essential for the general as well as specialty practitioners for the accurate diagnosis and proper treatment planning of these non cancerous but potentially destructive lesions and also opens new avenues for further research.

Awareness about oral cancer among dental postgraduate students in the State of Andhra Pradesh, India.

The aim of the study was to evaluate the knowledge and awareness of dental postgraduate students regarding risk factors, signs of oral cancer, and treatment plan and post treatment complications. A questionnaire was given to the 450 dental postgraduate students of all specialties to various dental colleges in Andhra Pradesh. The questionnaire included 10 questions pertaining to knowledge about oral cancer, its risk factors, key symptoms, and treatment plan and post treatment complications. Majority of postgraduate students were aware that habits (94 %) were the main risk factor for most of oral cancer whereas 50 % of students were aware of clinical presentation of oral cancer and 67 % were confident about the proper treatment protocol. Majority of the postgraduate students were aware of the main risk factors. On the other hand, several aspects like clinical signs of oral cancer, treatment protocol, referrals, and post treatment complications need to be improved. Continuing dental education programs and workshops on oral cancer should be carried out to enhance the knowledge and awareness of the postgraduate students.

Intraductal papilloma: atypical presentation.

Ductal papillomas have unique papillary features arising from the salivary gland duct system. They comprise three rare benign adenomas, namely, inverted ductal papilloma, sialadenoma papilliferum, and intraductal papilloma. Intraductal papilloma is an extremely rare benign salivary gland tumor that occurs most commonly in the minor salivary glands. Here, we are presenting a case report of intraductal papilloma in an 18-year-old patient.

Spinal cord injury in patients with ankylosing spondylitis: a 10-year review.

STUDY DESIGN: Retrospective study. OBJECTIVE: To evaluate the clinical and functional outcomes in patients with spinal cord injury (SCI) and preexisting ankylosing spondylitis (AS). SUMMARY OF BACKGROUND DATA: AS alters the strength and biomechanical properties of the spine that renders it susceptible to fracture with minimal trauma. Neurologic involvement is common and outcomes largely depend on the early recognition and appropriate management. METHODS: A 10-year review (1996-2005) was carried out to identify all patients admitted with SCI associated with AS. The cause of injury, prehospital and emergency management, definitive treatment of fracture, final neurology, and functional outcomes were ascertained. Reasons for neurologic deterioration were determined. RESULTS: Eighteen patients were identified. In 15 patients, the injury resulted from trauma (fall 14, road accident 1) and in 3 the SCI followed spinal surgical interventions. Twelve of the 15 patients with traumatic injuries were able to walk immediately after the fall but subsequently deteriorated for various reasons. Spinal epidural hematomas developed in 3 patients (2 traumatic, 1 spinal intervention). The fractures were managed surgically in 3 patients, halo jacket was used in 2, and the remainder were managed expectantly on traction. Four patients died before discharge, 4 were able to walk with an aid at discharge, and the others were wheel chair dependent. CONCLUSION: Neurologic deficits were often subtle on initial presentation, resulting in many injuries being missed because of a low index of suspicion and poor visualization of lower cervical fractures on conventional radiographs. Extension of the ankylosed kyphotic cervical spine during conventional immobilization or for radiologic procedures resulted in neurologic deficits. Patients with an ankylosed cervical spine are normally unable to see the ceiling lying supine because of cervicothoracic kyphosis and use pillows to support their head. Cervical spine alignment in a similar flexed position is essential during immobilization or imaging. Medical alert cards as for patients with diabetes would be a way forward in correctly identifying patients with AS so that appropriate precautions can be instituted by emergency services.

Enhanced coronary blood flow and abnormal blood flow in the aortic isthmus in severe fetal anemia.

Coronary arteries are not normally visualized by fetal echocardiograms. Reversal of flow in the transverse aortic arch is most often seen in association with severe coarctation. We describe a case of a near-term fetus whose fetal echocardiogram showed very prominent coronary arteries and severe reversal of flow in the transverse aorta suggestive of a coarctation who was postnatally confirmed to have normal intracardiac and aortic anatomy. We discuss the pitfalls in clinical diagnosis in this case to alert pediatric cardiologists of transient perturbations in physiology masquerading as heart disease.

Evaluation of a protocol for the non-operative management of perforated peptic ulcer.

BACKGROUND: The non-operative management of perforated peptic ulcer has previously been shown to be both safe and effective although it remains controversial. A protocol for non-operative management was set up in this hospital in 1989. Adherence to the guidelines in the protocol has been audited over a 6-year period with a review of outcome. METHODS: The case-notes of patients with a diagnosis of perforated peptic ulcer were reviewed. Twelve guidelines from the protocol were selected for evaluation of compliance to the protocol. RESULTS: Forty-nine patients underwent non-operative treatment initially. Eight patients failed to respond and underwent operation. Complications included abscess formation (seven patients), renal failure (one), gastric ileus (one), chest infection (two), and cardiac failure and stroke (one). Four deaths occurred in this group. Adherence to certain protocol guidelines was poor, notably those concerning prevention of thromboembolism, use of antibiotics, use of contrast examination to confirm the diagnosis and referral for follow-up endoscopy. Two gastric cancers were detected on subsequent endoscopy. CONCLUSION: This experience demonstrates that non-operative treatment can be used successfully in a general hospital. Adherence to protocol guidelines was found to be variable and the protocol has therefore been simplified. This study highlights the need for an accurate diagnosis and the importance of follow-up endoscopy.

Behavioural rehabilitation of head injured patients.

Behavioural changes constitute the most common disturbances following head injury. They are closely related to neurological damage, neuropsychological deficits and psychosocial maladjustments In an explorative study of behavioural rehabilitation inthe native setting, 101 patients with behavioural problems were included. For each individual a treatment programme including pharmacological, behavioural and psychotherapeutic intervention was planned and executed by a team of neurosurgeon, psychiatrist psychologist and social workers. The problem of non-compliance also was studied in the same group. Improvement was good in atypical psychoses, affective psychosis, alcohol dependency, phobias, sexual dysfunctions and undue somatic concern. Irritability, amotivation and disinhibited behaviour did not register adequate improvement. The study revealed the usefulness of multi-disciplinary model, deficiencies in the present approach, the need for adapting the techniques in conformity with native needs and the reason for non-compliance.

Vitamin and provitamin A levels in epithelial cancers: a preliminary study.

A major physiological role of retinoids is the regulation of epithelial and epidermal cell differentiation. A total of 285 patients with clinically and histopathologically confirmed diagnosis of various carcinomas (untreated) were selected for the study. The control values of serum beta-carotene and vitamin A levels were established from 50 subjects free of any known pathology. The controls were matched for age and sex. The mean serum levels of beta-carotene and vitamin A have shown a significant difference (p less than 0.001) in all the cancers compared with the controls. In cancer of the oral cavity, the males showed significantly lower levels (p less than 0.01) compared with their female counterparts. In cancer of the lung, however, the mean serum levels of beta-carotene and vitamin A were higher in males compared with females (p less than 0.02). Our results suggest a possible association between vitamin A and epithelial cancer, but whether the deficiency is the cause of the disease or if it is due to the tumor remains unknown.

Use of tannic acid for the ultrastructural visualization of periplasm in gram-negative bacteria.

Tannic acid mordanting reveals the periplasm, the area between the outer membrane and the inner membrane of gram-negative bacteria, Rhizobium sp., Escherichia coli and Enterobacter aerogenes, as an electron-dense layer continuous with the inner leaflet of the outer membrane. The method involves 18 hr of tannic acid treatment after fixation in aldehyde prior to osmium tetroxide postfixation, followed by conventional electron microscopy.

Vitamin B6 status in patients with cancer of the uterine cervix.

The activities of aspartate aminotransferase and alanine aminotransferase in erythrocytes with and without the addition of pyridoxal phosphate were determined in healthy controls and in Indian women with cancer of the uterine cervix. The percent stimulation of the erythrocyte transferases as a result of the addition of pyridoxal phosphate was negligible in the case of normal subjects (less than 5% stimulation). In the patients with cervical cancer, a 23-35% stimulation was observed, indicating a deficiency of vitamin B6. It is not yet known whether the deficiency is the cause of the disease or due to the tumor.